Burce Can

Prevalence of Metabolic Syndrome in Patients with Psoriasis

Background. Psoriasis is a chronic inflammatory skin disorder in which proinflammatory cytokines including IL-6 and TNF-α increase both locally and systematically. It is thought that chronic inflammation results in metabolic diseases and proinflammatory cytokines give rise to the development of atherogenesis, peripheral insulin resistance, hypertension, and type 2 diabetes. Our aim was to investigate the prevalence of metabolic syndrome in patients with psoriasis vulgaris. Methods. Study consisted of 115 plaque-type psoriasis patients and 140 healthy individuals. Data including body weight, height, waist circumference, body-mass index, and arterial blood pressure were collected. Fasting blood glucose, triglyceride, and HDL levels were determined. International Diabetes Federation Criteria for Metabolic Syndrome and Insulin Resistance were used for evaluating patients with metabolic syndrome and diabetes. Results. Compared to the control group, metabolic syndrome, diabetes mellitus, and hypertension were found to be higher in psoriasis patients. Metabolic syndrome was increased by 3-folds in psoriasis patients and was more prevalent in women than in men. It was determined that the prevalence of metabolic syndrome was higher in psoriasis patients after the age of 40. Metabolic syndrome was not related to smoking, severity of psoriasis, and duration of disease. Conclusions. Our findings suggest that psoriasis preconditions occurrence of a group of diseases such as diabetes mellitus, hypertension, and metabolic syndrome. For this reason, patients with psoriasis should be treated early and they should be followed with respect to metabolic diseases.

Significant improvement in ulcerative necrobiosis lipoidica with hydroxychloroquine

infiltrate with a variable amount of lymphocytes, histiocytes, and even eosinophils. In individuals of advanced age, it may beassociatedwithsignsofarteriosclerosis. Skin manifestations are uncommon. They consist of ischemia and necrosis, resulting from a total or partial reduction in the blood supply to the territory irrigated by the affected artery. In milder cases, there can be alopecia, hyperpigmentation, and sensitivity on the skull. Cases with an initial diagnosis of herpeszosterhavebeenreported. The first two cases of scalp necrosis as a manifestation of temporal arteritis were described by Cooke et al. in the 1940s. Since then, only 26 cases have been reported in the literature. Patients with scalp necrosis are older, with a greater risk of visual alterations and gangrene of the tongue, andaworseprognosis. This is a severe disease, especially because of the complications; however, most cases are now reversible and the mortalityrate is low.

The evaluation of thyroid diseases in patients with pemphigus vulgaris.

Background. Thyroid disorders may affect all of the organ systems of the body and they are also highly associated with a wide variety of skin disorders. The aim of this study was to investigate the prevalence of thyroid function abnormalities and thyroid autoimmunity in patients with pemphigus vulgaris (PV) and to determine the association between thyroid disorders and clinical involvement and systemic corticosteroid treatment in patients with PV. Methods. The study consisted of eighty patients with PV and eighty healthy individuals. Thyroid functions (fT3, fT4, and TSH) and thyroid autoimmunity (anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg) antibodies) were investigated in both groups. Primary thyroid disease (PTD) was diagnosed with one or more of the following diagnostic criteria: (i) positive antithyroid antibodies, (ii) primary thyroid function abnormalities. Results. Significant changes in the serum thyroid profile were found in 16% (13/80) of the PV group and 5% (4/80) of the control group. Positive titers of antithyroid antibodies (anti-TPO and anti-Tg) were observed in 7 patients (9%) with PV and one in the control group (1,2%). Hashimoto thyroiditis was diagnosed in 9% of PV patients and it was found to be more prevalent in the mucosal form of PV. PTD was found in 13 of (%16) PV patients which was significantly high compared to controls. PTD was not found to be associated with systemic corticosteroid use. Free T3 levels were significantly lower in PV group compared to the control group and free T4 levels were significantly higher in PV group compared to the controls. Conclusions. PV may exist together with autoimmune thyroid diseases especially Hashimoto thyroiditis and primer thyroid diseases. Laboratory work-up for thyroid function tests and thyroid autoantibodies should be performed to determine underlying thyroid diseases in patients with PV.

Treatment of pediatric molluscum contagiosum with 10% potassium hydroxide solution

Background: Molluscum contagiosum (MC) is a common cutaneous viral infection of the skin that is frequently seen in children. Although lesions can resolve spontaneously, treatment is mandatory because of the psychological effect of widespread lesions in children. Potassium hydroxide (KOH) is a strong alkali that has been used by dermatologists for a long time in identifying the fungal infections from skin scrapings. Aims: We evaluated 40 children with MC for the safety and efficacy of treatment with topical 10% KOH aqueous solution. Methods: Parents were instructed to apply a 10% KOH aqueous solution, twice daily, with a cotton stick to all lesions. Treatment was continued till the lesions showed signs of inflammation or superficial ulceration. Assessments of response and side effects were performed at the end of week 2, week 4, week 8 and week 12. Results: We found complete clearance of lesions in 37 (92.5%) patients receiving topical 10%KOH solution after a mean period of four weeks. Three children dropped out of the study; two children reported severe stinging of the lesions and discontinued the treatment; the other patient developed hypopigmentation during the treatment. Local side effects were observed in 12 children (32.4%). Conclusion: Even though 10% KOH solution is associated with some local side effects, it is a safe, effective, inexpensive and noninvasive alternative treatment of MC in children.

Ear, nose and throat involvement in patients with pemphigus vulgaris: correlation with severity, phenotype and disease activity

Background  Pemphigus vulgaris (PV) is the most common clinical form of pemphigus that is characterized by easily ruptured or loose bulla formation on skin and/or mucosa. The frequency of the ear, nose and throat involvement of PV is not clearly defined.

Vulvar pruritus caused by syringoma of the vulva

A 20-year-old woman presented with a 1.5-year history of pruritic papules on her vulva. There was no past history of eczema or contact sensitization. Cutaneous examination revealed multiple, 1-3 mm sized, skin-colored papules, distributed bilaterally over the labia majora (Fig. i). No other similar lesions were detected on the rest of the body. Histological examination of the lesion showed a tumoral lesion containing ductal structures formed by epithelial cells some of which were clear cytoplasm embedded in fibrotic stroma (Fig. 2). This appearance was diagnostic of a syringoma.

Autologous whole blood and autologous serum injections are equally effective as placebo injections in reducing disease activity in patients with chronic spontaneous urticaria: a placebo controlled, randomized, single-blind study

Abstract Background: Recent demonstration of circulating anti-IgG antibodies towards IgE and its receptor (FcϵRI) has led to an interest in inducing tolerance to circulating histamine-releasing factors with autologous blood injections as a treatment option in chronic spontaneous urticaria (CU). The aim of the study was to assess the efficacy of autologous whole blood (AWB) and autologous serum (AS) injections in patients with CU compared to placebo. Methods: A total of 88 CU patients with (+) autologous serum skin test (ASST) (59) and (-) ASST (29) were randomized into three parallel subgroups and were treated with weekly injections of AWB, AS or placebo for 10 weeks. Clinical assessments included urticaria activity score (UAS) and dermatology life quality index. Results: In ASST (+) patients, the percentages of patients with >30% improvement in UAS and DLQI were 85% and 90% in AWB group, 65% and 65% in AS group and 79% and 90% in placebo group, respectively. In ASST (-) patients, these figures were 67% and 89% in the AWB group, 80% and 80% in the AS group and 60% and 70% in the placebo group. The intergroup difference for complete subsidence was not statistically significant. Conclusions: Even though we could not show a better efficacy than placebo, autohemotherapy resulted in a marked decrease in disease activity and improvement in quality of life scores in CU patients.

Treatment of childhood mycosis fungoides with narrow-band phototherapy

46 Correspondence Treatment of childhood mycosis fungoides with narrow-band phototherapy Mycosis fungoides (MF) is a form of cutaneous T-cell lymphoma, usually arising in mid to late adulthood. 1 It is rarely described in children. 2,3 The most common presentation of MF diagnosed during childhood and adolescence is limited or generalized patch-stage disease without lymph node enlargement or with histologically negative nodes. 3,4 Herein, we present a patch-stage MF case in a Turkish girl who was treated successfully with narrow-band phototherapy. A 4-year-old girl is presented with disseminated asymptomatic hyperpigmented macules on her trunk. The lesions were first identified at the age of 18 months and further developed despite treatment with topical corticosteroids. Upon physical examination, she had erythematous, slightly scaly, irregularly bordered macules and patches of size 2–10 cm in diameter on her abdomen, flank, and left thigh. Sensation was normal and the lesions were not palpable (Figs 1 and 2). The result of a potassium hydroxide examination of the scale was negative. The histopathologic examination results revealed lymphocytes with darkly stained nuclei, either single or grouped, with extension along the dermo-epidermal junction and a bandlike infiltrate of large lymphocytes in papillary dermis (Fig. 3). Systemic examination and laboratory findings were found to be normal. Neither lymphadenopathy nor organomegaly were detected on clinical examination. According to the TNM (tumor, node, metastases) classification, the patient was in stage 1A (patch/plaques < 10% body surface area with no palpable lymph nodes). She received narrowband ultraviolet B (UVB) three times a week and had clinical and histological remission after a total of 30 sessions (total = 27 J/cm 2 ) over 2.5 months. She was then maintained on a regimen of once weekly for 5 months.

An extremely severe case of cutaneous calcinosis complicating adult dermatomyositis

A 44-year-old-woman presented with a violaceous rashaffecting the face and limbs, and multiple subcutaneousnodules and ulcers, muscle tenderness, and progressiveweakness, which had developed over the previous6 months. She had been diagnosed with dermatomyo-sitis (DM) 3 years previously, for which she had beentreated, but she did not continue regular treatment andlater stopped her medication.Physical examination revealed multiple, discrete andslightly tender firm nodules measuring up to 30 mm indiameter over the chest wall, axillary regions, arms,thighs, lower part of the abdomen and groins. Some ofthe nodules had central ulceration surrounded by areticulated or mottled erythematous skin (Fig. 1).Lactic dehydrogenase level was 531 U⁄L (normalrange 220–450); creatinine phosphokinase, serumcalcium and phosphate levels were all normal. Antinu-clear antibody was positive. A biopsy was taken from anodule on the left arm, which was interpreted asnodular calcinosis. Chest X-ray and abdominal andpelvic ultrasonographic examinations were normal.Radiological examination of the thighs revealed thepresence of numerous superficial and deep calciumdeposits having a popcorn-like appearance. Calcifica-tions around the humerus and at the proximal part ofthe femur and hips were found, in a coalescent, mottledand lacy pattern (Fig. 2). There were also linearcalcifications around the chest and axillary regions,the latter extending from each axilla to the elbow. Anelectromyogram and muscle biopsy confirmed thepresence of active myositis.A diagnosis of DM associated with cutaneous calci-nosis was made and the patient was started onprednisolone 75 mg⁄day, azathioprine 150 mg⁄dayand hydroxychloroquine 400 mg⁄day. The skin ulcers,myositis, difficulty in walking and abnormal laboratoryresults subsided within the first few months of treat-ment. The dose of prednisolone was gradually decreasedto 20 mg⁄day over 8 months and azathioprine wastapered to 100 mg⁄day over 16 months. The calcinosisgradually decreased in size and a marked regression wasnoted after 2 years of continuous therapy.Cutaneous calcinosis is an important complication ofDM, sometimes causing significant debility with severepain, joint contracture, skin ulcers and muscle atrophy.It is unusual in adults and reported to be more prevalentin juvenile DM. Lesions appear as hard nodules, oftenlocated over the elbows, knees and other acral areas.

Successful treatment of generalized childhood Schamberg's disease with narrowband ultraviolet B therapy

Pigmented purpuric dermatoses are a group of dermatoses characterized by petechia and hyperpigmented macules that occur predominantly on the lower extremities. Although it is most commonly seen in adults, this disease can also affect children. Phototherapy has been shown to be effective in some cases in the literature. Here, we present two cases of Schambergs disease that improved rapidly with narrowband ultraviolet B (UVB) therapy. To our knowledge, they were the first pediatric cases of successful narrowband UVB therapy in this disease.